lift 

\y 


UC-NRLF 


GIFT   OF 


Rehabilitation  of 
\the  War  Cripple 

By  Douglas  C.  McMurtrie 


^ 


DDITIONAL  copies  of  this  pamphlet  may  be 
obtained  without  charge  upon  application  to  the  Red 
Cross  Institute  for  Crippled  and  Disabled  Men, 
311  Fourth  Avenue,  New  York  City.  The  Institute 
is  also  prepared  to  furnish  specific  information  on  the 
organization  and  method  of  re-educational  work  in 
the  various  belligerent  countries,  as  well  as  on  the 
technique  of  training  and  employment  for  industrial 
cripples.  Correspondence  with  interested  individuals 
or  associations  is  invited. 


REHABILITATION    OF    THE    WAR    CRIPPLE 


ONE  of  the  major  costs  of  war  consists  in  the 
thousands  of  crippled  and  disabled  men  which 
are  left  in  its  train.  In  the  past,  such  soldiers 
have  been  indemnified  for  their  injuries — and  insuf- 
ficiently at  best — by  pension  bounty  or  admission  to 
soldiers'  homes.  In  either  instance,  they  have  been 
relegated  to  a  life  of  idleness  and  dependence.  These 
circumstances  tend  to  make  for  general  demoraliza- 
tion, and  the  popular  conception  of  the  adult  cripple 
as  lazy,  ill-mannered,  and  intemperate  has  too 
often  had  considerable  basis  of  experience.  This 
situation  has  been  regarded  as  unfortunate  but 
inevitable.  The  cripple  has  been  considered  as  a 
helpless  member  of  society,  to  be  pitied  and  main- 
tained, but  to  whom  constructive  assistance  was  not 
feasible. 

This  attitude  is  in  process  of  change,  for  it  has  been 
demonstrated  that  the  cripple,  though  debarred  by  his 
handicap  from  some  occupations,  could,  almost  with- 
out exception,  be  fitted  by  special  training  for  some 
trades  in  which  he  could  become  self-supporting  in 
spite  of  his  disability.  Several  influences  contributed 
to  progress  in  this  direction.  In  the  first  place  the 
great  increase  in  industrial  activity  during  the  past 
two  decades  brought  about  a  corresponding  increment 
in  the  number  of  employees  crippled  in  work  accidents. 
Injuries  were  particularly  frequent  in  the  period  before 
the  advent  of  the  safety  propaganda.  Again,  the  state 
— especially  in  Europe — became  intimately  identified 

til 


382213 


REHABILITATION    OF    THE    WAR    CRIPPLE 

with  workmen's  compensation,  and  in  many  instances 
itself  assumed  responsibility  for  the  payment  of  the 
compensation  award. 

The  waste  involved  in  the  complete  support  of 
thousands  of  workmen  injured  in  more  or  less  serious 
degree  became  soon  apparent,  and  the  authorities 
cast  about  for  some  means  to  decrease  the  per- 
centage of  disability.  The  solution  was  found — 
notably  in  Belgium  and  France — in  trade  schools  for 
the  re-education  of  the  crippled  victims  of  industrial 
accidents.  In  these  schools  the  man  who  has  lost  the 
use  of  his  leg  is  trained  for  a  trade  at  which  he 
can  work  while  seated;  the  man  lacking  an  arm  is 
prepared  for  an  occupation  in  which  two  legs  and 
the  sound  arm  suffice  for  its  pursuit.  Since  the 
demand  for  skilled  labor  generally  exceeds  the  sup- 
ply, it  is  entirely  practical  to  place  at  steady  employ- 
ment men  trained  thoroughly  in  a  wisely  selected 
trade.  Of  course  there  are  many  difficulties  to  over- 
come, but  with  patience,  success  is  not  only  possible, 
but  probable. 

The  provision  of  training  for  disabled  men  received 
a  tremendous  impetus  at  the  opening  of  the  present 
war.  With  the  call  of  the  able-bodied  population  to 
arms,  the  ensuing  shortage  of  labor  necessitated  the 
draft  into  industry  of  women  and  old  men.  No  po- 
tential productivity  could  be  neglected,  and  the  re- 
habilitation of  the  physically  disabled  became  a 
national  necessity.  The  dictates  of  national  gratitude 
and  national  economy  in  this  instance  coincided,  and 
in  conjunction  have  stimulated  extensive  and  vigor- 
ous activity. 

[2] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

The  first  country  to  make  actual  and  adequate  pro-/ 
vision  for  the  re-education  of  war  cripples  was  France. 
In  December,  1914,  Edouard  Herriot,  Mayor  of  . 
Lyons,  obtained  the  consent  of  his  municipal  council 
to  establish  a  training  school  for  mutiles  de  la  guerre. 
This  school — later  christened  the  Ecole  Joffre — actu- 
ally opened  its  doors  to  the  first  three  pupils  in  the 
same  month  in  which  its  foundation  was  authorized. 
Since  then  the  institution  has  grown  phenomenally, 
and  a  suburban  branch  has  been  opened  at  Tourvielle. 
These  two  centers  have  served  as  examples  for  other 
schools  since  started  in  other  cities  throughout  the 
Republic. 

In  England  the  early  work  was  undertaken  by 
private  initiative,  but  the  responsibility  is  now  na- 
tional, the  reconstruction  work  being  carried  on  under 
the  direction  and  at  the  expense  of  the  Pensions 
Ministry.  Germany  projected  an  ambitious  program 
in  the  early  weeks  of  the  war,  and  made  actual  begin- 
nings toward  its  realization  but  little  later  than  the 
French  work  was  under  way.  In  Canada  a  federal 
commission  began  promptly  the  establishment  of  con- 
valescent homes  and  training  classes.  In  Italy,  hard 
upon  her  entrance  into  the  war,  there  were  organized, 
to  provide  for  the  rehabilitation  of  crippled  soldiers, 
a  series  of  local  committees  which  were  later  co-ordi- 
nated under  national  authority.  jj 

Since  the  economic  rehabilitation  of  men  disabled 
in  the  war  is  a  matter  of  such  vital  moment,  not  only  to 
the  individual  but  to  the  state  as  well,  it  is  essential 
that  any  work  undertaken  be  wise  in  plan,  and  thor- 
ough in  execution.  It  may  be  desirable,  therefore,  to 


REHABILITATION    OF    THE    WAR    CRIPPLE 

inquire  into  the  principles  already  developed  in  this 
new  and  promising  field. 

II 

:.  - 

The  wounded  soldier  comes  through  the  field  a^id 
base  hospital,  and,  finally,  if  his  disability  is  such  as 
to  disqualify  him  from  further  military  service,  he  is 
returned  from  overseas  to  a  convalescent  hospital  at 
home.  Certainly  at  this  point,  if  not  perhaps  earlier, 
preparation  for  his  social  and  economic  rehabilitation 
should  begin. 

Before  deciding  what  can  best  be  done  for  him,  the 
recent  experience  of  the  crippled  soldier  must  be 
taken  into  account.  In  the  first  place,  he  has  been 
away  from  home  influence  and  environment  for  some 
time — perhaps  one  year,  perhaps  three.  During  that 
period  he  has  led  a  life  in  the  open,  free  from  the  many 
routine  responsibilities  of  the  civilian.  He  has  been 
provided  automatically  with  every  necessity  of  life — 
his  only  reciprocal  obligation  being  to  obey  the 
mandates  of  military  discipline.  After  his  injury  he 
has  been  given  every  care  which  the  medical  corps  and 
its  auxiliaries  have  been  able  to  provide.  Every  ef- 
fort has  been  made  to  minimize  worry  or  exertion  on 
his  part.  These  influences  have  the  effect  of  deaden- 
ing his  initiative  and  his  sense  of  social  responsibility, 
and  readjustment  to  civil  life  becomes  in  consequence 
more  difficult. 

The  new  handicap  usually  throws  the  man  into  a 
state  of  extreme  discouragement.  The  loss  of  a  hand, 
an  arm,  or  a  leg  seems  to  the  man  formerly  able-bodied 
an  insuperable  obstacle  to  his  future  economic  activ- 


REHABILITATION    OF    THE    WAR    CRIPPLE 

ity.  The  prospective  pension  is  the  only  mitigating 
feature -of  this  depressing  outlook,  and  he  begins  to 
calculate  how  he  can  exist  on  the  meager  stipend  which 
will  become  his  due.  He  has  basis  for  this  expecta- 
tion, for  has  he  not  known  in  the  past  several  men 
each  of  whom  lost  a  limb  through  accident?  It  was 
necessary  for  them  to  eke  out  a  living  by  selling  pencils 
on  the  'street,  or  in  some  similar  enterprise  of  make- 
shift character.  Again,  life  will  hold  no  pleasure  in 
the  future;  he  will  always  feel  sensitive  about  his 
missing  limb.  Besides,  nobody  has  any  use  for  a 
cripple. 

Such  a  state  of  mind  will  be  encountered  in  the  \ 
convalescent  soldier.  It  must  be  met  and  overcome. 
With  returning  health,  initiative  must  be  reawakened, 
responsibilities  quickened,  a  heartened  ambition  must 
replace  discouragement.  We  can  go  to  him  and 
truthfully  say:  "If  you  will  yourself  help  to  the  best 
of  your  ability,  we  will  so  train  you  that  your  handi- 
cap will  not  prove  a  serious  disadvantage;  we  will 
prepare  you  for  a  job  at  which  you  can  earn  as  much 
as  in  your  previous  position.  Meantime  your  family 
will  be  supported  and  maintained.  You  will  be  pro- 
vided with  a  modern  artificial  limb  so  that  a  stranger 
would  hardly  know  you  are  crippled.  Finally,  we  will 
place  you  in  a  desirable  job." 

The  first  reaction  to  this  program  is  fear  that  an 
increase  of  earning  power  will  entail  a  reduction  of 
pension.  When  re-education  of  war  cripples  was  first 
begun  in  both  France  and  Germany,  it  was  found  that 
many  of  the  men  were  unwilling  to  undertake  training, 
in  apprehension  of  prejudicing  their  pension  award. 

[51 


REHABILITATION    OF    THE    WAR    CRIPPLE 

The  solution  of  the  difficulty  was  official  announce- 
ment that  such  would  not  be  the  case,  but  that  pen- 
sions would  be  based  on  degree  of  physical  disability 
alone,  without  reference  to  earning  power.  In  Can- 
ada, a  placard  to  this  effect  is  posted  in  all  military 
hospitals  and  convalescent  homes. 

The  choice  of  trades  in  which  war  cripples  may 
wisely  be  trained  is  of  primary  importance.  In  addi- 
tion to  considering  whether  men  with  certain  types 
of  physical  disability  can  engage  in  a  given  trade,  its 
present  and  prospective  employment  possibilities  must 
be  taken  into  account.  If  it  is  a  seasonal  trade,  if  the 
number  of  workers  in  any  locality  is  so  small  as  to 
make  difficult  the  absorption  of  many  newly-trained 
men,  or  if  the  industry  is  on  the  wane  rather  than  en- 
joying a  healthy  growth,  the  indications  are  negative. 
The  ideal  trade  is  one  in  which  the  wage  standards  are 
high,  the  employment  steady,  and  the  demand  for 
labor  constantly  increasing.  In  picking  trades  the 
present  boom  conditions  should  be  discounted.  Ma- 
chinists are  now  earning  fabulous  wages,  but  it  should 
be  considered  whether  there  will  not  be  an  extreme 
reaction  after  the  war. 

The  trades  actually  being  taught  to  war  cripples 
are  many  and  varied.  In  France  at  the  notable  Ecole 
Joffre  at  Lyons  there  is  instruction  in  accounting  and 
commercial  subjects,  toymaking,  bookbinding,  shoe- 
making,  woodwork,  mechanical  drafting,  tailoring, 
wood-carving,  gardening,  and  machine  tool  work.  At 
the  suburban  branch  at  Tourvielle,  agricultural  courses 
are  given.  In  Paris  at  the  Institut  National  Profes- 
sionel  des  Invalides  de  la  Guerre  are  taught  the  stan- 

[6] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

dard  trades  of  tailor,  shoemaker,  harnessmaker,  and 
tinsmith.  Also,  dependent  on  the  ability  of  the  indi- 
vidual pupil,  instruction  is  provided  in  accounting, 
industrial  design,  cabinet-making,  and  automobile 
engineering — particularly  the  operation  and  repair  of 
agricultural  tractors. 

In  Rome,  the  Italian  war  cripples  are  being  taught 
commercial  subjects,  carpentry  and  wood-carving, 
bookbinding,  box-making,  saddlery,  and  leather  work, 
shoemaking,  tailoring,  and  blacksmithing.  At  Naples 
there  is  instruction  in  shoemaking,  tailoring,  tele- 
graphy, and  commercial  subjects. 

The  school  in  connection  with  the  Maximilian  Hos- 
pital at  Petrograd  offers  a  considerable  range  of 
courses,  among  them  the  following:  manufacture  of 
orthopedic  apparatus,  locksmithing,  shoemaking,  cab- 
inet-making, and  tailoring. 

At  Niirnberg,  Germany,  the  crippled  soldier  learns 
to  become  a  blacksmith,  locksmith,  maker  of  ortho- 
pedic apparatus,  machinist,  cobbler,  tailor,  cabinet- 
maker, saddler,  upholsterer,  weaver,  paint-brush 
maker  (a  strong  local  industry),  printer,  or  book- 
binder. There  is  also  instruction  in  industrial  design 
as  applied  in  varied  fields.  At  the  Dusseldorf  school 
instruction  is  given  in  machine  tool  work,  mechanical 
drafting,  building  trades,  telegraphy,  and  commercial 
and  civil  service  subjects. 

In  England,  the  workshops  of  the  Incorporated  Sol- 
diers and  Sailors  Help  Society  provide  training  in  the 
following  trades:  carpentry  and  cabinet-making, 
printing,  polishing,  carving  and  gilding,  picture  fram- 
ing, toy-making,  basket-making,  metal  work,  building 

[7] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

and  construction,  decorating,  and  electrical  fitting. 
The  principal  subjects  at  Roehampton  and  Brighton 
(Queen  Mary's  Convalescent  Auxiliary  Hospitals)  are 
inside  electrical  wiring,  motor  driving  and  repairs,  and 
woodworking,  which  includes  bench  and  lathe  prac- 
tice. At  Cliveden  and  at  other  points  in  Britain 
agricultural  training  is  available. 

In  the  Canadian  schools,  under  the  auspices  of  the 
Military  Hospitals  Commission,  the  leading  trades  are 
motor  mechanics,  machine-tool  work,  carpentry  and 
woodturning,  inside  electrical  wiring,  telegraphy,  cob- 
bling, operation  of  agricultural  tractors,  general  farm- 
ing, and  poultry  raising.  Instruction  is  also  provided 
in  bookkeeping,  general  office  work,  and  civil  service 
subjects. 

The  section  of  the  country  in  which  a  man  lives  also 
has  a  bearing  on  the  choice  of  a  trade  in  which  he  is 
to  receive  instruction.  Thus,  a  Canadian  living  in 
Montreal  may  be  trained  as  a  machinist;  the  same 
man,  if  a  resident  of  a  far  western  province,  would 
better  be  given  instruction  in  the  operation  of  motor 
tractors  for  agricultural  work. 

It  is  axiomatic  that  a  man  should  be  given  his  course 
of  training  in  a  locality  near  home.  Here  he  will  not 
feel  so  strange,  friends  will  not  be  far  away,  and  the 
educational  authorities  will  be  in  closer  touch  with 
the  local  industrial  requirements  and  employment 
conditions. 

ill 

It  is  the  general  consensus  of  experience  that  the 
decision  by  the  man  to  undertake  a  course  of  training 

[8] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

must  be  a  voluntary  one.  Of  course,  he  may  be 
retained  in  the  military  organization  and  detailed  to 
trade  classes  in  the  same  way  as  he  is  detailed  to 
guard  duty,  but  this  would  not  make  for  successful 
results.  The  unwilling  and  rebellious  pupil  learns  but 
little;  the  earnest  and  ambitious  one  makes  rapid 
progress.  The  man  must  be  persuaded,  therefore,  to 
take  up  instruction ;  the  future  advantages  of  being  a 
trained  workman  in  some  skilled  trade  should  be 
pointed  out,  and  the  practical  arrangements  to  be 
made  for  him  during  the  course  of  instruction  care- 
fully explained.  There  is  no  royal  road  to  success  in 
this  effort,  but  after  gaining  the  soldier's  friendship 
and  confidence,  a  patient  persistence  will  win  the 
battle.  If  a  competent  visitor  has  been  in  touch 
with  the  man's  family  during  his  absence  at  the 
front,  the  members  of  the  home  circle  can  be  easily 
convinced  of  the  wisdom  of  his  re-education;  this 
will  make  all  the  simpler  persuasion  of  the  man 
himself. 

A  great  aid  in  helping  a  soldier  to  decide  about  his 
future  is  acquaintance  with  the  records  of  other  men 
with  similar  physical  handicaps  who  have  made  good 
— men  who  have  been  trained  and  who  are  now  hold- 
ing jobs  at  attractive  wages.  In  addition,  such  prac- 
tical results  lend  plausibility  to  the  expectations  in 
prospect  which  are  being  held  out  to  him.  A  difficulty, 
however,  is  found  in  the  abnormal  premium  on  indus- 
trial labor  in  war  time.  Even  a  disabled  man  may  be 
able  to  go  out  and  earn  seven  dollars  a  day  in  a  mu- 
nitions factory.  This  constitutes  a  very  potent  present 
counter-attraction  to  representations  of  moderate  but 

[91 


REHABILITATION    OF    THE    WAR    CRIPPLE 

permanent  employment  after  a  course  of  training.  If 
he  makes  the  opportunist  choice  he  will,  upon  the 
return  of  employment  conditions  to  normal,  be  re- 
duced to  the  status  of  a  casual  laborer,  perilously  near 
the  verge  of  mendicancy.  No  pains  should  be  spared 
to  avert  this  eventuality. 

Care  should  be  taken,  however,  that  representations 
to  the  man,  while  encouraging,  should  in  the  main  be 
accurate.  Workers  with  crippled  soldiers  should  not 
be  misled  by  reports  of  extraordinary  success  in  iso- 
lated cases.  The  men  will,  sooner  or  later,  learn  the 
truth,  which  will  thus  tend  to  discredit  the  veracity 
of  the  vocational  officials. 

In  deciding  which  of  the  available  courses  an  indi- 
vidual disabled  soldier  should  pursue,  the  first  effort 
should  be  to  fit  him  for  an  occupation  related  as  closely 
as  possible  to  his  former  job.  His  past  experience — 
far  from  being  discarded — should  be  built  upon.  A 
competent  journeyman  bricklayer  who  has  lost  an 
arm  may  be  prepared  by  a  suitable  course  in  architec- 
tural drafting  and  the  interpretation  of  plans,  to  take 
a  position  as  construction  foreman  of  a  bricklaying 
gang.  It  were  idle  to  give  such  a  man  a  course  in 
telegraphy.  But  a  train  hand  who  has  been  all  his  life 
familiar  with  railroad  work  may  most  wisely  be  trained 
as  a  telegraphic  operator,  with  a  little  commercial 
instruction  on  the  side.  This  man  will  then  be  fitted 
to  obtain  employment  as  station  agent  at  some  minor 
point  on  the  road.  There  is  an  additional  advantage 
in  instances  such  as  the  two  mentioned  in  that  the 
former  employer  will  be  willing  to  engage  again  a  man 
with  whose  record  and  character  he  is  familiar — once 

[10] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

there  is  assured  the  competence  of  the  ex-soldier  in 
his  new  capacity. 

This  rule  applies,  however,  only  to  men  who  were, 
previous  to  their  enlistment,  operatives  in  the  skilled 
trades.  Their  problems  are  the  simplest  of  solution. 
But  in  the  present  war,  when  not  only  professional 
soldiers,  but  whole  nations  are  in  arms,  there  will  re- 
turn disabled  many  young  men  who  had  not  yet 
attained  a  permanent  industrial  status.  Some  will 
have  entered  the  army  direct  from  high  school  or  col- 
lege; others  will  have  been  migratory  workers  who 
had  not  yet  found  a  permanent  niche  and  whose  ex- 
perience has  been  too  varied  to  be  of  much  value,  still 
others  will  have  been  drawn  from  unskilled  and  ill-paid 
occupations  which  hold  little  future  opportunity  for 
the  able-bodied  worker,  and  almost  none  for  the  phys- 
ically handicapped.  Among  the  latter  will  be  found 
those  who  have  been  forced  to  leave  school  and  go  to 
work  at  too  early  an  age,  and  to  whom  society  has 
not  given  a  fair  chance.  When  they  now  return  from 
the  front  crippled  for  life  and  having  made  a  great 
patriotic  sacrifice,  it  is  surely  the  duty  of  the  state  to 
repair  so  far  as  practicable  the  former  inequality  of 
opportunity,  and  provide  for  them  the  best  possible 
training.  It  would  be  a  cause  for  national  pride  if,  in 
the  future,  such  men  could  date  their  economic  suc- 
cess from  the  amputation  of  their  limb  lost  in  their 
country's  service.  And  this  is  entirely  within  the 
realm  of  probability. 

With  these  latter  classes  there  is,  therefore,  no  for- 
mer experience  of  value  to  serve  as  a  guide  in  the 
choice  of  a  trade  in  which  the  war  cripple  is  to  be 

[11] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

trained.  We  must  then  fall  back  on  the  general  prin- 
ciples of  vocational  guidance.  The  more  important 
factors  will  be  natural  talent,  personal  preference  or 
taste,  habits  of  work,  temperament,  and  the  general 
character  of  the  individual.  Advice  in  each  case 
should  be  given  by  an  expert  vocational  counsellor,  a 
man  familiar  at  once  with  trade  education,  with  the 
requirements  of  the  various  industries  themselves, 
and  with  the  current  status  of  the  labor  market. 
His  opinion  should  take  into  account  the  report 
and  prognosis  of  the  medical  officer,  and  also  the 
past  record  of  the  individual.  As  has  been  pointed 
out,  the  friendship  and  confidence  of  the  soldier 
are  absolutely  essential.  Very  often  these  are  difficult 
of  attainment  and  the  prospective  pupil's  reserve 
is  penetrated  only  in  the  fourth  or  fifth  visit.  As  the 
decision  to  undertake  training  at  all  must  be  volun- 
tary, so  must  the  choice  of  particular  trade  meet 
with  the  full  approval  of  the  soldier  himself.  And 
if,  after  beginning  the  course,  the  subject  proves 
definitely  distasteful,  the  opportunity  to  change 
to  another  trade  should — within  reasonable  limita- 
tion— be  permitted.  It  cannot  be  too  strongly  em- 
phasized that  the  unwilling  pupil  is  a  poor  learner 
indeed. 

It  would  seem  inadvisable  to  train  a  man  for  an 
occupation  which  he  can  pursue  only  by  use  of  special- 
ized apparatus  adapted  to  the  individual  motor  limi- 
tations imposed  by  his  deformity.  While  a  badly 
crippled  man  may  be  taught  to  operate  a  lathe  with 
special  treadles  or  to  run  a  typewriter  with  special 
paper  feed  and  shifting  mechanism,  his  employment 

[12] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

opportunities  will  be  precarious.  It  may  be  possible 
to  secure  for  him  one  specific  job  which  may  be  ar- 
ranged for  at  the  time  he  starts  training.  But  if  he 
cannot  get  along  personally  with  his  employer,  if  his 
family  must  move  to  another  city,  if  his  wages  are 
not  advanced  as  his  product  increases — for  these  and 
a  myriad  other  reasons,  he  may  become  practically 
unable  to  obtain  other  employment,  and  the  value  of 
his  training  will  be  thus  nullified.  Ingenuity  should 
be  directed  rather  to  fitting  crippled  men  to  meet 
the  demands  of  standard  trades,  in  which  there 
will  be,  not  one  or  a  dozen  possible  jobs,  but  thou- 
sands. Only  thus  can  the  man  be  made  actually 
independent. 

It  is  absolutely  essential  that  training,  if  provided 
at  all,  be  thorough.  The  pupils  are  men,  not  boys, 
and  they  cannot  go  out  in  the  apprenticeship  category, 
as  do  the  graduates  of  regular  trade  schools — and  even 
in  these  the  present-day  standards  of  proficiency  are 
high.  If  ill-trained  men  are  graduated  from  the  classes 
the  results  will  not  be  fortuitous.  Employers  will  be 
convinced  that  the  theory  of  re-educating  returned  sol- 
diers is  unsound;  the  men  will  come  to  distrust  the 
representations  of  prospective  success  which  have  been 
made  to  them.  There  will  be,  further,  an  unjustified 
disturbance  of  the  labor  market  and  its  wage  standards 
if  a  school  turns  out  into  a  trade  as  professedly  skilled 
operatives  a  crowd  of  undertrained  and  inexperienced 
men.  Schools  of  re-education  must  not  contribute  to 
difficulties  of  this  character. 

One  of  the  most  notable  features  of  the  work  in 
France  is  the  length  of  some  courses  in  which  the  war 


REHABILITATION    OF    THE    WAR    CRIPPLE 

cripples  are  trained.  To  even  comparatively  simple 
subjects  instruction  periods  of  twelve  and  eighteen 
months  are  allotted.  This  permits  the  men  to 
obtain  not  only  a  theoretic  education,  but  a  fair 
degree  of  practical  experience  as  well — an  experi- 
ence which  is  of  especial  necessity  in  restoring 
to  the  soldiers  a  confidence  in  their  own  compe- 
tency. 

IV 

The  attitude  of  the  public  toward  the  returned 
soldier  will  do  much  to  make  or  mar  the  success  of 
work  with  the  war  cripples.  The  man  returning  dis- 
abled from  the  front  deserves  the  whole-hearted  grati- 
tude and  respect  of  the  nation,  but  to  spoil  and 
pamper  him  is  an  ill-advised  way  of  meeting  the  obli- 
gation. Parents  who  wish  to  do  the  best  possible  by 
their  children  do  not  manifest  affection  by  spoiling 
their  digestion  with  an  eagerly  received  surfeit  of 
candy.  They  rather  seek  to  provide  a  good  home 
environment,  exert  a  firm  but  kindly  discipline,  and 
obtain  for  their  children  the  best  educational  op- 
portunities. In  other  words,  the  emphasis  is  on 
values  of  permanence.  The  same  general  principles 
apply  in  the  relations  of  the  public  to  the  ex-service 
man. 

In  one  of  the  allied  countries  the  wife  of  a  returned 
soldier  complained  to  the  representative  of  a  patriotic 
relief  agency,  which  had  been  attending  to  the  family 
needs  while  the  chief  breadwinner  was  at  the  front, 
that  her  husband  would  never  spend  any  time  with 
her  or  with  the  children.  She  had  wanted  that  after- 

[14] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

noon  to  have  him  accompany  them  to  the  park,  but 
he  disdainfully  refused,  saying  that  he  was  going  out 
for  an  automobile  ride  and  later  to  a  'sing-song*  at  one 
of  the  fashionable  hotels.  The  musical  entertainment 
referred  to  was  being  provided  by  the  society  ladies  of 
the  city,  so  mother  and  the  children  went  to  the  park 
alone,  while  the  'hero*  was  receiving  appropriate 
recognition  of  his  services. 

Of  course  the  most  pernicious  expression  of  this 
attitude  is  the  indiscriminate  'treating'  of  the  disabled 
soldier  at  the  corner  saloon — except  of  course  in  those 
localities  which  have  made  this  more  or  less  impossi- 
ble by  the  enactment  of  total  prohibition. 

In  some  cities  the  'patriotic'  hysteria  of  the  public 
has  been  such  that  neither  the  police  nor  the  military 
authorities  are  in  a  position  to  restrain  or  punish 
returned  soldiers,  even  when  they  have  become  seri- 
ously disorderly  and  objectionable.  This  is  no  kind- 
ness to  the  men  and  casts  a  most  unfavorable  reflection 
on  the  service  as  a  whole. 

On  the  other  hand,  the  nation  cannot  go  too  far  in 
showing  gratitude  to  the  war  cripple,  provided  the 
manner  of  its  expression  is  sound.  To  give  him  the 
best  of  medical  care,  a  first-rate  artificial  limb,  a 
thorough  and  capable  training  to  fit  him  for  a  remu- 
nerative trade,  and  a  chance  of  employment  a  little 
better  than  the  average — these  constitute  the  real 
public  duty,  a  duty  not  so  simple  of  fulfillment  as  the 
mere  provision  of  social  entertainment. 

The  one  form  of  expression  should  be  frowned  upon 
as  actually  unpatriotic ;  the  other  should  be  promoted 
and  encouraged.  Some  propaganda  for  public  edu- 


REHABILITATION    OF    THE    WAR    CRl'PPLE 

cation  in  this  respect  may  become  necessary,  if  the 
plans  for  the  war  cripple  are  to  be  worked  out  to  a 
thoroughly  successful  conclusion. 

v 

The  greatest  obstacle  in  the  past  to  the  success  of 
schools  for  the  trade  training  of  adult  cripples  lay  in 
the  support  of  the  pupil  during  the  period  of  the 
course.  A  school  could  offer  the  best  of  facilities,  and 
be  in  a  position  to  practically  promise  a  man  at  the 
conclusion  of  its  course  a  position  at  double  his  former 
wages,  yet  the  prospective  pupil  could  not  even  con- 
sider the  proposition  because  meanwhile  he  could  not 
manage  to  exist,  and  must  needs  continue  at  even  the 
worst  type  of  makeshift  occupation. 

But  with  the  soldier  cripple,  this  difficulty  disap- 
pears. The  man  is  already  on  the  payroll  of  the  state, 
he  has  been  injured  in  Ms  country's  service,  and  it  is 
logical  and  proper  that  he  should  be  adequately  sup- 
ported until  he  is  fitted  for  repatriation.  His  military 
pay  and  the  separation  allowance  to  his  family  should 
both  be  continued,  or,  if  discharged  from  the  army, 
corresponding  training  stipends  awarded;  with  such 
provision  he  can  enter  upon  his  training  in  peace  of 
mind — without  which  the  instruction  could  not  be 
effective.  If  the  institution  he  attends  is  a  boarding 
school,  maintenance  would  also  be  provided;  if  it 
were  wise  for  the  man  to  live  at  home  there  could  be 
made  a  further  allowance  in  commutation. 

To  complete  physical  rehabilitation  in  amputation 
cases,  artificial  limbs  must  be  supplied.  At  the  out- 
break of  the  war,  the  supply  of  limbs  presented  to  the 

[16] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

European  countries  a  most  difficult  problem.  The  de- 
mand was  many  times  greater  than  it  had  ever  been 
in  the  past,  and  the  major  portion  of  the  continental 
supply  had  always  been  drawn  from  Germany.  In 
the  emergency  thousands  of  appliances  were  imported 
from  the  United  States,  which  has  always  been  cred- 
ited with  making  the  best  artificial  limbs.  Later  the 
various  belligerent  countries  began  to  manufacture 
limbs  themselves.  The  factories,  operating  under  of- 
ficial auspices,  are  enabled  to  utilize  any  patented 
features  without  paying  royalties. 

Each  limb  must  be  made  to  individual  specifications 
and  fitted  to  the  stump  of  the  patient  who  is  to  wear  it. 
This  makes  desirable  centralization  of  this  activity. 
In  Canada,  for  instance,  all  amputation  cases  go  to  a 
hospital  in  Toronto  with  an  accommodation  of  four 
hundred;  here  the  limbs  are  manufactured,  fitted,  and 
applied. 

That  a  stump  shrinks  for  some  time  after  amputa- 
tion introduces  one  element  of  difficulty,  in  that  a 
limb  which  fits  six  months  after  amputation  may  come 
far  from  doing  so  after  twelve  months.  For  this  rea- 
son it  may  be  wise  to  provide  the  soldier  at  first  with 
a  simple  temporary  limb,  and  later  with  a  more  elabo- 
rate and  permanent  one.  He  must  be  quite  explicitly 
assured  of  this  plan,  however,  as  he  will  otherwise 
become  suspicious  of  being  put  off  with  an  inferior 
article. 

Very  remarkable  results, in  cases  of  arm  amputation 
are  now  being  accomplished  by  prosthesis,  i.  e.,  the 
fitting  to  the  stump  of  special  appliances.  Thus,  in- 
stead of  being  provided  with  a  well-appearing  arti- 


REHABILITATION    OF    THE    WAR    CRIPPLE 

ficial  arm,  there  will  be  attached  to  his  stump  a  chuck 
in  which  he  can  insert  interchangeably  a  knife,  a  fork, 
a  tool,  a  hook,  or  some  special  implement  by  which 
to  guide  or  steady  work  on  which  he  is  engaged.  These 
'working  prostheses'  are  often  individually  to  meet  the 
requirements  of  the  particular  trade  which  their 
wearer  is  to  follow. 

Both  prosthetic  apparatus  and  artificial  limbs  ad- 
vantage by  simplicity.  When  too  complicated  the 
men  lose  faith  in  and  discard  them.  For  some  types 
of  manual  workers  it  may  be  wise,  for  instance,  to 
provide  the  primitive  'peg  and  bucket'  leg  for  use  in 
working  hours,  and  in  addition  a  more  esthetic  type 
for  wear  on  Sundays  and  holidays. 

VI 

As  the  choice  of  trades  should  be  influenced  by  the 
labor  conditions  of  the  community,  so  must  employ- 
ment of  the  graduates  be  closely  integrated  with  the 
course  of  instruction.  Not  only  must  a  position  be 
secured  for  the  re-educated  soldier,  but  he  must  be 
placed  as  intelligently  as  possible.  To  the  man  the 
work  must  be  satisfactory  and  the  environment  agree- 
able; to  the  employer  the  personality  of  the  soldier 
must  be  acceptable  and  his  product  sufficient  to  the 
requirements.  Of  course,  this  ideal  can  only  be  ap- 
proximated, but  a  trained  and  capable  employment 
officer  can  do  much  in  this  direction.  Only  by  skilled 
and  thorough  work  can  permanent  results  be  ob- 
tained— and  nothing  is  more  costly  to  all  parties  con- 
cerned than  short-time  employment  and  frequent 
change  of  job. 

[18] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

Ten  men  placed  in  ten  jobs  by  the  opportunist 
method  of  sending  the  first  available  applicant  to  the 
first  available  position  may  be  unhappy  themselves 
and  unsatisfactory  to  their  employers.  Yet  the  same 
ten  under  different  and  wiser  placement  direction  may 
be  almost  ideally  located  in  the  same  jobs.  It  is  to 
this  end  that  tends  the  natural  system  of  employment 
and  discharge,  but  it  is  a  costly  method  and  one  that, 
for  the  crippled  soldier,  should  be  made  unnecessary. 

The  first  job  for  the  man  returned  from  the  front  is 
easy  to  secure — so  easy  that  we  should  not  be  misled 
by  the  superficial  indications.  The  employer  is  patri- 
otic and  anxious  to  help  the  crippled  soldiers.  But 
when  the  war  shall  have  been  over  a  few  years,  these 
motives  will  be  no  longer  effective.  The  man  taken 
on  in  a  time  of  national  stress  will  be  just  one  of  the 
employees,  and  his  retention  in  service  will  depend 
upon  performance  alone.  If  the  original  placement 
was  intelligent  the  man  will  have  made  progress, 
gained  confidence  and  experience,  and  made  his  po- 
sition sure.  If,  on  the  other  hand,  he  was  ill-fitted  for 
the  job,  he  will  have  grown  progressively  less  efficient 
and  in  consequence  discouraged,  and  his  status  will  be 
precarious  indeed.  A  permanent  injury  might  thus 
result  from  an  employment  bungle  in  the  first  in- 
stance. All  this  simply  means  that  effective  place- 
ment is  not  an  amateur  job. 

Employment  work  for  returned  soldiers  would  be 
immensely  facilitated  by  the  enactment  of  national 
prohibition.  In  one  province  of  Canada  placement  of 
soldiers  is  extremely  difficult,  and  for  some  men  ten 
and  fifteen  positions  must  successively  be  obtained, 

[19! 


REHABILITATION    OF    THE    WAR    CRIPPLE 

each  job  being  lost  for  one  reason  only — intoxication. 
In  a  neighboring  province,  with  prohibition,  these  dif- 
ficulties do  not  appear.  Soon,  by  virtue  of  recent 
legislation,  traffic  in  liquor  will  be  forbidden  in  all 
parts  of  the  Dominion;  we  should  not  fail  ourselves 
to  profit  by  this  example.  The  chance  of  successful 
rehabilitation  will  be  tremendously  enhanced  by  pro- 
tecting the  men  from  the  influence  of  the  saloon. 

The  actual  methods  of  placement  need  not  be  here 
discussed,  but  to  one  feature  attention  may  be  called. 
Disabled  soldiers  must  be  regarded  as  a  special  class. 
The  transition  from  military  to  civilian  life  involved 
in  entering  on  the  first  job  is  a  more  radical  step  than 
is  taken  by  the  average  employee  going  from  one 
position  to  another.  The  placement  must,  therefore, 
be  followed  up  after  the  first  few  days  of  work,  the 
apprehensions  of  the  'green'  employee  must  be  dis- 
pelled, his  difficulties  adjusted,  and  his  confidence 
fortified.  If  this  follow-up  can  be  done  by  a  person 
whom  the  ex-soldier  knows  and  trusts,  it  will  be  all 
the  more  effective. 

vn 

Should  the  support  and  direction  of  after-care  for 
the  war  cripple  be  public  or  private?  The  answer  to 
this  question  is  unequivocal — the  responsibility  is 
most  emphatically  a  national  one.  This  can  be  dem- 
onstrated not  only  as  a  matter  of  principle  but  also  by 
actual  experiential  results. 

From  the  viewpoint  of  principle,  it  may  be  con- 
cluded that  the  returned  soldier  should  not  be  de- 
pendent for  one  of  his  most  vital  necessities  on  the 

[20] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

dole  of  private  charity,  for  which  is  expected  a  grate- 
ful appreciation.  Were  the  work's  auspices  of  such 
character  it  would  materially  prejudice  the  attitude 
of  the  men.  The  soldiers  might  very  logically  object 
to  passing  around  the  hat  in  order  to  provide  for  them 
facilities,  the  need  of  which  is  not  open  to  argument. 
There  should  be  not  the  least  hint  of  patronage  or 
pauperization  in  this  partial  restitution  made  by  the 
state  to  those  who  have  been  disabled  in  its  service. 

Empirically,  the  indications  for  public  assumption 
of  responsibility  are  all  positive.  The  most  obvious 
point  lies  in  the  uncertainty  that  the  facilities  privately 
provided  shall  be  commensurate  with  the  demands. 
In  the  wealthy  urban  centers  schools  for  re-education 
would  be  numerous  and  well-equipped;  in  the  rural 
sections  and  in  the  smaller  cities  there  might  be  almost 
no  provision  at  all.  It  would  be  intolerable  did  a 
crippled  soldier  from  Arizona  have  any  less  chance  for 
future  success  than  his  fellow  veteran  from  Boston  or 
New  York. 

Again,  the  extent  and  thoroughness  of  the  work 
would  be  subject  to  fluctuation,  varying  with  the 
results  obtained  in  solicitation  of  funds.  The  income 
would  likewise  adversely  be  affected  by  a  competing 
financial  campaign — another  issue  of  Liberty  Bonds, 
a  second  Red  Cross  week,  might  mean  dropping  a 
useful  subject,  shortening  a  course,  refusing  admission 
to  some  eligible  applicants. 

Under  private  control,  furthermore,  the  standard  of 
work  would  vary  greatly.  The  schools  would  not 
have  the  advantage  of  central  direction  by  expert  and 
capable  executives.  There  is  also  no  riper  field  for 

[21] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

the  expression  of  mawkish  sentimentality  than  in 
caring  for  the  crippled  or  blind,  and  the  injured  soldier 
must  be  protected  from  becoming  its  victim.  With 
schools  operated  under  local  auspices  there  would  be 
a  few  good  ones,  and  many  of  the  indifferent  variety. 
And  there  is  no  problem  more  delicate  than  that  of 
coping  with  ill-directed  and  silly  charitable  enter- 
prises. One  can  picture  the  invective  of  local  news- 
papers if  the  military  authorities  refused  to  assign 
soldiers  to  a  certain  institution  because  its  standards 
of  administration  and  instruction  were  considered  be- 
low par.  The  time  to  avert  such  predicaments  is 
prior  to  their  rise. 

Let  us  consider,  on  the  other  hand,  the  advantages 
accruing  from  centralized  public  control.  The  factor 
of  most  moment  is  the  character  the  work  then  as- 
sumes in  its  relation  to  the  individual  war  cripple.  It 
becomes  regarded  much  as  is  the  public  school  system ; 
the  soldier  is  thus  entitled  to  training  by  virtue  of  his 
rights  as  a  citizen  and  an  honorable  public  servant. 
There  is  of  charity  no  taint  whatever. 

With  an  acknowledged  national  responsibility,  the 
facilities  provided  can  keep  pace  with — or,  indeed, 
ahead  of — the  requirements.  The  work  can  be  carried 
out  on  a  plan  fixed  in  advance,  and  its  standards  be 
consistent  country-wide. 

Another  advantage  of  federal  control  lies  in  the 
simplicity  of  integration  between  the  medical  and  edu- 
cational interests.  The  former  is  under  military  and, 
therefore,  national  authority,  and  simplification  of 
procedure  cannot  but  result  from  having  the  latter  of 
like  scope.  The  training  classes  must  in  many  in- 

[22] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

stances  be  carried  on  in  medical  institutions,  as  there 
is  a  considerable  period  of  convalescence  in  which  the 
men  should  be  under  re-education.  Again,  one  of  the 
principal  method  of  restoring  disabled  soldiers  to 
health  is  the  prescription  of  specified  exercise,  and  it 
has  been  found  that  this  is  best  gained  in  workshops 
rather  than  with  mechanotherapeutic  apparatus. 
Finding  that  they  can  do  some  practical  thing,  how- 
ever simple,  is  immensely  encouraging  to  men  who 
may  have  lost  all  hope  of  future  usefulness.  Occupa- 
tional therapy  plays  now  one  of  the  leading  roles  in 
the  convalescent  treatment  of  the  wounded,  and  this 
makes  all  the  more  desirable  a  close  relation  between 
the  two  branches  of  the  work. 

A  central  and  national  direction  of  the  work  for 
war  cripples  does  not  in  the  least  preclude  the  utili- 
sation of  volunteer  effort  and  facilities.  In  fact, 
voluntary  contribution  of  time  and  money  is  highly 
desirable,  particularly  in  committing  more  people  to  a 
first-hand  interest  in  the  enterprise,  and  in  giving  the 
schools  root  in  their  local  communities.  Buildings  can 
be  loaned,  trade  school  classrooms  and  equipment 
made  available,  machinery  and  apparatus  for  instruc- 
tion donated,  funds  contributed,  and  personal  service 
volunteered.  Existing  organizations  can  offer  to  pro- 
vide the  necessary  social  service  work  in  the  homes  of 
the  men;  local  employment  agencies  can  be  of  help 
by  acting  links  in  the  national  chain. 

Such  private  assistance  will  be  more  than  desirable; 
it  will  be  essential.  Because  provision  for  war  cripples 
is  a  temporary  problem,  and  it  would  not  be  wise  to 
erect  new  buildings,  equip  expensive  machine  shops, 

[23] 


REHABILITATION    OF    THE    WAR    CRIPPLE 

and  build  up  a  complete  and  self-sufficient  organiza- 
tion for  a  few  years'  work.  For  trade  classes  it  will  be 
better  to  obtain  the  use  for  part  time  of  shops  in  exist- 
ing schools — institutions  which  will  be  in  position 
to  afford  such  facilities  on  account  of  the  number  of 
their  regular  students  who  will  have  been  called  to 
arms.  In  England,  the  technical  institutes  are  being 
widely  used;  in  France,  many  war  cripples  are  being 
instructed  in  the  regular  schools  of  agriculture. 

But  under  these  conditions  the  private  contribu- 
tion helps  rather  than  hampers  the  effectiveness  of  the 
national  plan. 

It  may  be  remarked  in  passing  that  the  facilities 
built  up  for  war  cripples  will  not  be  entirely  temporary, 
but  that  part  will  be  continued  to  provide  re-training 
for  industrial  cripples — a  class  more  numerous  even 
in  time  of  war  than  disabled  soldiers,  but  one  whose 
needs  have  in  the  past  been  seriously  neglected.  This 
may  be  one  beneficent  outcome  of  belligerency. 

A  concrete  program  for  the  reconstruction  of  dis- 
abled American  soldiers  and  sailors  has  not,  at  this 
writing,  been  determined  upon.  It  is  clear,  however, 
that  the  responsibility  for  this  work  will  be  nationally 
assumed.  The  details  of  system  and  method  can 
easily  be  worked  out  under  competent  administration, 
but  it  is  imperative  that  definite  action  be  taken 
without  delay  so  that  preparation  of  facilities  for 
our  returning  men  can  be  set  at  once  under  way. 

Let  us  discharge,  to  the  highest  possible  degree,  the 
nation's  obligation  to  the  war  cripple.  Let  us  so  act 
in  this  greatest  of  all  wars  as  to  mitigate  the  shame  of 
his  treatment  in  the  past. 

[24] 


UNIVERSITY  OF  CALIFORNIA  LIBRARY 
BERKELEY 

Return  to  desk  from  which  borrowed 
This  book  is  DUE  on  the  last  date  stamped  belc 


MAY  27  1987 


50H 


REC/D 
OEC  28  1956 


LD  21-100m.9,'47(A5702S16)476 


GAYLAMOUNT 
PAMPHLET  BINDER 

^ 

Monufodutcd  by 
GAYLORD  BROS.  l«. 
Syracuse,  N.  Y. 
Stockton, 


U.C.  BERKELEY  LIBRARIES 


06 


THE  UNIVERSITY  OF  CALIFORNIA  LIBRARY 


